Quality cancer care requires accurate and precise risk stratification, especially for early stage cancers. A large proportion of incident bladder cancer cases are diagnosed at early stage (<T2) and have highly heterogeneous progression risks. In particular, we know little about low-risk, noninvasive carcinoma, which comprises nearly half of all incident cases. Bladder cancer care after early stage diagnosis often requires frequent, costly, and invasive testing to identify recurrence at clinically actionable stages. Surveillance tailored to risk could enable us to provide more efficient and personalized care by identifying which patients are likely to benefit from more aggressive management. To address these challenges, we will create a contemporary, valid, and comprehensive risk stratification tool for use in the US. We will also develop concrete strategies for its implementation and dissemination. Our risk calculator will have demonstrated validity in the US and will use readily-available clinical data. We will also identify clinical decision support (CDS) tools and processes for integrating the risk calculator in diverse health care settings. Our proposed approach for designing risk-stratification interventions could help translate research about cancer recurrence and progression into rational clinical practices that focus resources on the patients who have the highest risk of recurrence and progression while minimizing the burden on patients with low-risk disease. The proposed study also represents a unique opportunity to answer questions about bladder cancer epidemiology, care quality, cost, and managing early-stage disease.